Salute to Service Dogs

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The psychological and moral comfort of a presence at once humble and understanding—this is the greatest benefit that the dog has bestowed upon man. Percy Bysshe Shelley

Ever since their domestication about 20,000 years ago, dogs have been cherished for their indomitable and generous spirit, ability to assist humans in myriad ways, and unconditional love. August heralds National Dog Month, and September honors the loyal companionship and dedicated work of service dogs so valuable to service members and veterans.

The nature of their special training to perform specific tasks for the safety and well-being of veterans distinguishes service dogs from pets or emotional support animals. Most of us recognize the happiness and meaning animals bring to our lives. What we may not appreciate is the impressive contribution service dogs make to the health and rehabilitation of those who have served their country. Veteran patients with neurologic conditions such as seizures know the difference a service dog trained to warn them of an emerging seizure makes for their freedom of movement and peace of mind. Veterans with diabetes have described times when their service dogs sought help before they realized their blood sugar was dangerously low.

Patients, friends, and neighbors who have been paired with service dogs describe ways their new companion helped them transition from a life in which even surviving was a struggle to one of holistic thriving. A Vietnam veteran neighbor with a significant tremor due to Parkinson disease benefitted from the ability of his dog to fetch and bring, retrieve, and carry. His dog has learned to hold essential items still, which would otherwise be too shaky in human hands, enabling the veteran to open his closet door and dress independently each morning. One veteran classmate avoided all forms of public transportation due to memories of a traumatic mobile-based mass evacuation she assisted with during her military service. She dreaded her long, inconvenient daily drive back and forth to work. She was then partnered with a large dog breed that was trained to stand a short distance from her to protect her sense of space and open air. The dog would stretch out his body to claim more space for her among crowds. This veteran started to ride the bus to campus each morning and appreciated the interaction with other riders as well as the saved travel time, mileage, gasoline expense, and parking stress.

A veteran brought his sweet retriever to the neighborhood weekly “Paws-itive Reading” program for children in the local public library. When MW’s daughter was busy reading to his furry friend, the veteran shared that for at least 5 years after his combat tours, he rarely left his window-shuttered home. His dog’s steady comfort re-established his ability to participate in his community. He now generously shares his dog’s patient affection with children learning to read.

MW recently witnessed the profound and protective presence of a service dog in comforting a veteran during a posttraumatic stress disorder (PTSD)–related crisis. The service dog offered a lean and reassuring paw pressure on the veteran’s shoulder if he was reexperiencing trauma. The dog’s steady breathing and familiar warmth helped to reorient their human companion to the safety of his present physical surroundings. Bearing witness to the dog’s trained interaction with the veteran left MW speechless. The trust between them was therapeutic in a way that transcended her ability to articulate what she experienced. This compelled MW to investigate whether this was a rare relationship or whether there was existing data on the impact of trained service dogs and PTSD.

Service dog placement with veterans with PTSD has been shown to have a positive influence on both physiological (arousal-related functioning and cortisol awakening response) and psychosocial well-being, including decreased isolation and increased physical activity.1,2 Veterans with PTSD paired with service dogs showed significantly fewer PTSD-related symptoms, better sleep quality, and improved well-being, compared with those with just a pet.3 A recent meta-analysis revealed that veteran partnerships with a service dog had a clinically meaningful, significant, and large effect on PTSD severity scores (P < .001).2 The mechanism for impact is thought to be not only the dog’s working role but also the transcendent loyalty of the canine-veteran bond.

Many accredited dog training programs describe a certain reciprocity to the dog-human relationship. Some use rescue puppies to give the dogs a new life and purpose. Dogs who have undergone challenges often need patience, time, safe relationships, and trustworthy new experiences to maximize their potential. Reciprocally, trained service dogs have the potential to foster access to these same emotional, relational, existential, and physical safety needs for veterans exposed to trauma.

Recent legislation has made progress in recognizing the role of service dogs for veterans and improving access. The Puppies Assisting Wounded Servicemembers (PAWS) for Veterans Therapy Act (38 USC §1705, 1714) was passed in 2021. The PAWS Act implemented a policy and 5-year pilot program to connect trained canines to eligible veterans diagnosed with PTSD as an element of an integrative health program, regardless of whether the veteran has a mobility impairment. The PAWS Act gives federal funding to accredited dog training organizations to help pair eligible veterans with service dogs by covering veteran travel expenses for the training, training program participation, and relevant veterinary expenses. The bipartisan Service Dogs Assisting Veterans Act (SAVES) Act was introduced this summer to award grants to nonprofit organizations Assistance Dog International has accredited to help these groups provide service dogs to veterans.

The US Department of Veterans Affairs (VA) has made strides in welcoming service dogs. Trained service dogs of all breeds under the control of a human companion are now allowed in VA facilities other than in areas where safety and infection control standards would be compromised (ie, sterile equipment rooms).4 A prescribing clinician can now evaluate eligible veterans to determine their ability, resources, and goals for having a service dog.5 An assessment of the veteran’s ability to care for a dog and education on expectations for the partnership is critical to success and animal welfare. Those veterans approved for a service dog are then referred to accredited agencies. The VA Veterinary Health Insurance Benefit includes aspects of coverage for the veteran to attend service dog training, veterinary wellness (preventive care, immunizations, dental cleanings, certain prescriptions, etc), and care for the dog’s illnesses when treatment enables the dog to perform duties in service to the veteran.6

The productive purpose and friendship of a service dog become a formidable force in a veteran’s life. Veterans spent an average of 82% of their time with service dogs (assessed via Bluetooth proximity between collar and smartphone).7 Human partners of veterans with service dogs may experience improved quality of life and relationship functioning with the inclusion of a service dog in the family unit.8 Veterans depict increased community engagement, social connectedness, and personal confidence as a result of the canine companionship.9,10 Veterans with service dogs often speak of the ways the dog’s presence transformed their lives and many speak of the dog literally saving their lives.11 Meta-analyses showed improved mental health treatment engagement, medication adherence, and decreased suicidality.2,12

A story was recently shared with us about the compassion and competence of VA staff in a perioperative unit. A veteran was scheduled for a life-altering surgery and yet was anxious about entering the room for his scheduled pre-anesthesia check-in, knowing his service dog could not accompany him through the entire procedure. The staff recognized that the veteran was increasingly nervous and even started to question whether he would stay for the scheduled procedure they deemed would benefit his health. The perioperative team then proactively worked together to safely walk the veteran through the preparation processes in a sterile setting while keeping the dog within sight of the veteran. They then ensured that the veteran’s service dog was by his side early in the recovery room so that the veteran woke to wags and licks. In these months of canine recognition, we honor the ways the VA has fostered companionship and courage in veterans’ lives through the inclusion of service dogs in so many aspects of their care and life.

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